Admissions to paediatric medical wards with a primary mental health diagnosis: a systematic review of the literature

Objective: To systematically review the literature describing children and young people (CYP) admissions to paediatric general wards because of primary mental health reasons, particularly in MH crisis. Design: PubMed, Embase, PsychINFO, Web of Science and Google Scholar were searched. We addressed five search questions to inform: trends and/or the number of admissions, the risk factors for adverse care, the experiences of CYP, families/carers and health care professionals (HCPs) and the evidence of interventions aimed at improving the care during admissions. Two reviewers independently assessed the relevance of abstracts identified, extracted data and undertook quality assessment. This review was registered with Prospero (CRD42022350655). Results: Thirty-two studies met the inclusion criteria. Eighteen addressed trends and or numbers/proportions of admissions, 12 provided data about the views/experiences of HCPs, two provided data about CYPs experiences and four explored improving care. We were unable to identify studies examining risk factors for harm during admissions, but studies did report the length of stay in general paediatric/adult settings while waiting for specialised care, which could be considered a risk factor while caring for this group. Conclusions: MH admissions to childrens wards are a long-standing issue and are increasing. CYP will continue to need to be admitted in crisis, with paediatric wards a common allocation whilst waiting for assessment. For services to be delivered effectively and for CYPs and their families/carers to feel supported and HCPs to feel confident, we need to facilitate more integrated physical and MH pathways of care.